Healthcare Provider Details

I. General information

NPI: 1477047033
Provider Name (Legal Business Name): SARAH MARIE RICHTER LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EZRA NYLE RICHTER LLMSW

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 FULTON ST E STE 222
GRAND RAPIDS MI
49503-3262
US

IV. Provider business mailing address

233 FULTON ST E STE 222
GRAND RAPIDS MI
49503-3262
US

V. Phone/Fax

Practice location:
  • Phone: 616-490-3468
  • Fax: 616-369-1281
Mailing address:
  • Phone: 616-490-3468
  • Fax: 616-369-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851116429
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: